Spontaneous Spinal Epidural Hematoma in a Patient on Apixaban for Nonvalvular Atrial Fibrillation

Table 1

Cases of SSDH and SSEH associated with the use of DOACs described in the literature.

Study	Age of the patient (Years), gender	Presenting symptoms	DOAC used	Site (epidural/subdural)	Radiographic findings	Intervention used	Time from last DOAC dose to procedure (>24 hours)	Onset of neurologic deficit symptoms to intervention (>24 hours)	Reversal agent used	Recovery/marked improvement
This case	76, F	Severe back pain and progressing LUE and LLE weakness and numbness	Apixaban	Epidural	CT: epidural hematoma from C2-C3 to C6-C7	C2–C7 laminectomy and hematoma evacuation	Yes	Yes	None	No
Jaeger et al. [1]	61, F	Severe back pain with bilateral LE weakness and numbness	Rivaroxaban	Epidural	MRI: epidural hematoma C2–T8	None	N/A	N/A	None	Yes
Bamps et al. [2]	70, M	Severe cervical pain, tetraplegia, sensory loss, and severe autonomic instability	Dabigatran	Epidural	CT: C2–C4 epidural hematoma	C2–C4 laminectomy and hematoma evacuation	No	No	Prothrombin complex concentrate	Yes
Ozel et al. [3]	69, F	Severe cervical pain followed by quadriplegia	Rivaroxaban	Epidural	CT: C2–C4 epidural hematoma	None	N/A	N/A	None	Yes
Ismail et al. [4]	72, M	Severe back pain, bilateral lower extremities weakness and numbness, and urinary incontinence	Rivaroxaban	Epidural	MRI: T11-L2 epidural hematoma	T11–L2 laminectomy and hematoma evacuation	No	No	Fresh frozen plasma	Yes
Goldfine et al. [5]	74, M	Gradual onset neck pain and waxing and waning paralysis of all extremities with fecal incontinence	Rivaroxaban	Epidural	MRI: foramen magnum-C7 epidural hematoma	Surgery and hematoma evacuation	Yes	No	None	U/K
Zaarour et al. [6]	58, M	Sudden back pain with progressive numbness in bilateral lower extremities followed by progressive weakness	Rivaroxaban	Subdural	MRI: C7-T2 subdural hematoma with edema	Steroids followed by laminectomy and evacuation	Yes	Yes	Aminocaproic acid	Yes
Castillo et al. [7]	69, M	Excruciating back pain with progressing lower extremities weakness leading to paraplegia and bowel and bladder dysfunction	Rivaroxaban	Subdural	MRI: T3-Conus medullaris subdural hematoma	Cervical and lumbar CSF drains	Yes	Yes	None	No
Dargazanli et al. [8]	72, M	Back pain, flaccid paraplegia, positive Babinski, thermalogic hypoesthesia, absent knee and ankle reflexes, and decreased anal tone	Rivaroxaban	Subdural	MRI: T6–T8 subdural hematoma	T6–T8 laminectomy with hematoma evacuation, received IV steroids after surgery	Yes	Yes	Prothrombin complex concentrate	No
Colell et al. [9]	75, F	Paraparesis, hyperreflexia, hypoesthesia, no plantar reflex on the left	Dabigatran switched to apixaban before episode	Subdural	MRI: large subdural hemorrhage with discontinuous cervical-dorsal-lumbosacral involvement with secondary spinal cord compression	D1–D3 vertebral laminectomy with hematoma evacuation followed by D4–D7 laminectomy with hematoma evacuation 1 week later	Yes	Yes	None	Yes
Radcliff et al. [12]	53, F	Pain in the right buttock and leg, numbness in bilateral buttock and sensation of incomplete bladder emptying	Rivaroxaban	Epidural	MRI: spinal epidural hematoma at right L4-L5	L4-L5 laminectomy and evacuation of hematoma	U/K	No	None	Yes